This Article Full Text Full Text (PDF) All Versions of this Article: 35/3/682    most recent 01.STR.0000117251.65222.DAv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nonent, M. Search for Related Content PubMed PubMed Citation Articles by Nonent, M. Related Collections Carotid Stenosis Computerized tomography and Magnetic Resonance Imaging Doppler ultrasound, Transcranial Doppler etc. Carotid endarterectomy

(Stroke. 2004;35:682.)
© 2004 American Heart Association, Inc.

Original Contributions

Concordance Rate Differences of 3 Noninvasive Imaging Techniques to Measure Carotid Stenosis in Clinical Routine Practice

Results of the CARMEDAS Multicenter Study

Michel Nonent, MD; Jean-Michel Serfaty, MD, PhD; Norbert Nighoghossian, MD; François Rouhart, MD; Laurent Derex, MD; Carmen Rotaru, MD; Pierre Chirossel, MD; Bruno Guias, MD; Jean-François Heautot, MD; Pierre Gouny, MD; Bernard Langella, MD; Valérie Buthion, PhD; Isabelle Jars, PhD; Chahin Pachai, PhD; Charles Veyret, MD; Jean-Yves Gauvrit, MD; Michel Lamure, PhD Philippe C. Douek, MD, PhD for the CARMEDAS Study Group

From the Departments of Radiology (M.N.), Vascular Medicine (B.G.), Neurology (F.R.), and Vascular Surgery (P.G.), University Hospital Center, Brest; Departments of Radiology (J.-M.S., C.R., P.C., P.C.D.), Neurology (N.N., L.D.), and UMR CNRS 5515 Creatis (M.N., J.-M.S., P.C.D.), University Hospital Center, Lyon; Department of Radiology, University Hospital Center, Rennes (J.-F.H., B.L.); Theralys, Lyon (C.P.); Department of Radiology, University Hospital Center, St-Etienne (C.V.); Department of Radiology, University Hospital Center, Lille (J.-Y.G.); and Laboratory of Health Systems Analysis, University of Lyon, Lyon (V.B., I.J., M.L.), France.

Correspondence to Michel Nonent, Service de Radiologie, Bd Tanguy Prigent, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France. E-mail michel.nonent{at}chu-brest.fr

Background and Purpose— To replace digital subtraction angiography (DSA) in carotid stenosis evaluation, noninvasive imaging techniques have to reach a high concordance rate. Our purpose is to compare the concordance rates of contrast-enhanced MR angiography (CEMRA) and CT angiography (CTA) with Doppler ultrasound (DUS) in clinical routine practice.

Methods— We evaluated prospectively with DUS, CEMRA, and CTA 150 patients suspected of carotid stenosis. The overall concordance rates of the 3 techniques were calculated for symptomatic stenosis 50% and 70%, for asymptomatic stenosis 60%, and for occlusion. For the carotid arteries treated by surgery (n=97), the results of each method and combined techniques were recorded, and misclassification rates were evaluated from surgical reports.

Results— The overall concordance rates of DUS-CEMRA, DUS-CTA, and CEMRA-CTA were not statistically different. However, the concordance rate of DUS-CEMRA (92.53%) was significantly higher than that for DUS-CTA (79.10%) in the surgical asymptomatic stenosis group (P=0.0258). CTA considered alone would misclassify the stenosis in a significant number of cases (11 of 64) in the surgical asymptomatic group compared with CEMRA (3 of 67) and DUS (1 of 66) (P=0.0186 versus MRA, P=0.0020 versus DUS).

Conclusions— With the techniques as utilized in our study, the overall concordance rates of combined noninvasive methods are similar for measuring carotid stenosis in clinical routine practice, but in asymptomatic carotid stenosis, the decision making for surgery is significantly altered if DUS and CTA are considered in place of DUS and CEMRA.

Key Words: carotid endarterectomy • carotid stenosis • computed tomography • magnetic resonance angiography • ultrasonography, Doppler

This article has been cited by other articles:

				J. M. U-King-Im, M. J. Graves, J. J. Cross, N. J. Higgins, J. Wat, R. A. Trivedi, T. Tang, S. P. S. Howarth, P. J. Kirkpatrick, N. M. Antoun, et al. Internal Carotid Artery Stenosis: Accuracy of Subjective Visual Impression for Evaluation with Digital Subtraction Angiography and Contrast-enhanced MR Angiography Radiology, July 1, 2007; 244(1): 213 - 222. [Abstract] [Full Text] [PDF]

				K. R. Nandalur, A. D. Hardie, P. Raghavan, M. J. Schipper, E. Baskurt, and C. M. Kramer Composition of the Stable Carotid Plaque: Insights From a Multidetector Computed Tomography Study of Plaque Volume Stroke, March 1, 2007; 38(3): 935 - 940. [Abstract] [Full Text] [PDF]

				M. Lell, C. Fellner, U. Baum, T. Hothorn, R. Steiner, W. Lang, W. Bautz, and F.A. Fellner Evaluation of Carotid Artery Stenosis with Multisection CT and MR Imaging: Influence of Imaging Modality and Postprocessing AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 104 - 110. [Abstract] [Full Text] [PDF]

				J. M. Serfaty, M. Nonent, N. Nighoghossian, F. Rouhart, L. Derex, C. Rotaru, P. Chirossel, G. Thabut, B. Guias, J-F Heautot, et al. Plaque density on CT, a potential marker of ischemic stroke Neurology, January 10, 2006; 66(1): 118 - 120. [Abstract] [Full Text] [PDF]

				V. L. Wright, W. Olan, B. Dick, H. Yu, N. Alberts-Grill, L. L. Latour, and A. E. Baird Assessment of CE-MRA for the rapid detection of supra-aortic vascular disease Neurology, July 12, 2005; 65(1): 27 - 32. [Abstract] [Full Text] [PDF]

				T. E. Feasby and J. M. Findlay CT angiography for the assessment of carotid stenosis Neurology, August 10, 2004; 63(3): 412 - 413. [Full Text] [PDF]